UPFRONT

No Longer Blinded by the Light

Peter K. Kaiser, MD

“Blinded by the light
Mama always told me not to look into the sights of the sun
Oh but mama that's where the fun is”
— Bruce Springsteen, Greetings from Asbury Park, NJ

With my last car, I would constantly have oncoming cars blink their headlights at me mistakenly, believing that my brights were on. They weren’t, but the car had xenon headlights that lit up the road like the sun. They also lit up everything else, and hence, many upset drivers were blinded by my lights. In contrast, one of my partner’s cars, a 1955 Chevy Series 1 pick-up truck, never gets blinked. It has a wrap-around windshield, with round, shrouded vintage headlights and iffy brakes. The circular headlights light up the road just fine, although only directly in front of the truck.

My new car has the latest LED lighting technology. They light up the road even better than my old xenon lights but can be precisely aimed so they light up the ground and not oncoming drivers. Even better, when I turn the steering wheel, the lights swivel to light up the direction I am now heading. It goes without saying that the new lights are much safer for everyone, as I am not blinding people with my lights, and I can see the road better.

Like cars, lighting in vitreoretinal surgery has undergone major changes since I was a fellow at Bascom Palmer. The vintage halogen lights we used during my fellowship are like the Chevy pick-up truck. The light was so dim and the field of view so small that we would have to hold them close to the vitrector tip to visualize the vitreous or near the retinal surface when peeling membranes.

Wide-angle lights arrived along with wide-angle viewing systems, dramatically improving surgical safety because we no longer had to hold the lights so close to the retina, and we could see what we were doing away from our instruments. Like in cars, halogen lights gave way to xenon sources that made it possible to use wide-angle lights through smaller and smaller fiber optics. This changed the early microincision surgeries that felt like we were operating in a tunnel to the views we were used to in 20-gauge. Chandelier lights through self-sealing cannulas allowed us to perform bimanual surgeries without needing a tissue manipulator. All these advancements made surgery safer and more efficient. Now, we even have systems to filter the colors of the lights. Whether this adds even more safety remains to be seen, but advancements in lighting are sure to continue.

In this issue, we explore the lighting advances in vitreoretinal surgery. I am sure we will see LED lights very shortly in the OR, and who knows — maybe one day light probes based on the laser headlights being tested by BMW.

As for the quote, many assume this lyric was written by Manfred Mann’s Earth Band for their Number 6 hit, but it was really penned by the Boss and was the first song on the Greetings from Asbury Park, NJ, album. Springsteen sang it at the Stone Pony on the Jersey Shore well before Snooki and her friends could blind people with their car lights!